By JESSICA SIEFF
Niles Daily Star

While the debate surrounding health care reform rages on the nation’s capital, all eyes are on how to care for America’s uninsured and how to best take care of those who are insured – including those at the local level.

Last week, House Republicans presented the state with their plan to balance Michigan’s budget.

And that, representatives Matt Lori (Cass), Sharon Tyler (Niles) and John Proos (St. Joseph) said –  means tough decisions.

In their plan, on the list of immediate cost saving measures that take aim at several state departments including general government, agriculture, human services, environmental quality and labor and economic growth – the largest department to see proposed cuts, to the tune of $361.7 million, is community health.

“You’re always struggling to maximize the dollars that you have,” Proos said Monday, on his way back from a meeting with the Job Task Force in Traverse City.

“The big challenge that we had in balancing this budget without raising taxes or fees,” while remaining realistic, Proos said, was finding ways to cut the strings attached to state dollars through the American Recovery and Reinvestment Act.

“Community health has a significant amount of those dollars,” he said.

The proposed budget includes cuts to state psychiatric hospitals and centers and non-Medicaid special health services – but its biggest withdrawal is a $150 million reduction in funding “available to mental health services for non-Medicaid persons and substance abuse services.”

During the unveiling of the proposed budget plan, the idea of tough decisions, not unlike those being made at the kitchen tables of Michigan state residents, was emphasized by each of the area representatives.

That mindset continues.

The amount, Proos said is 65 to 70 percent of dollars which could have been cut.
So are area services worried?

Colleen Lerret, with the Berrien County Health Department’s Substance Abuse and Prevention division said the threat of cuts to programs and services are something the organization faces every year and that it’s “too soon to tell” should the proposed cuts make it through Lansing, just what kind of affect they would have on her department.
“The program will still be here,” Lerret said. “The program will still be offering services.”
The Substance Abuse and Prevention division of the Berrien County Health Department operates under funding that comes from a block grant through the state as well as Medicaid and drug court.

“It’s not an elimination of the program,” Proos assured. “It’s a savings within the program.”

Lawmakers, in drafting the plan, he added, “fought to maintain” as much as they could while putting together the proposals.

Now, it seems another fight is brewing on behalf of those who stand to possibly be affected by those cuts.

“It’s really a recipe for community disaster,” said Sally Reames CEO of Community Healing Center, the only other substance abuse treatment center in the county besides the health department.

Reames worries that a “great divide” is only getting bigger between the need for the “services we believe in” and the resources available for them.

The Community Healing Center is funded through a state block grant as well, along with Medicaid reimbursement, V.A. Contract reimbursement, self pay and private insurance.
Cutting funding to the programs could cost the state more money in the long run, she said. As more and more people in need of help find themselves unable to get it, hospitals and law enforcement find themselves forced to handle the cleanup.

Reames estimates “16 percent of the state budget (is spent) cleaning up after the problems associated with it (substance abuse). For every dollar spent cleaning up,” she said, “one penny is spent on treatment.”

Still, Reames said she understands the challenge facing lawmakers and the need for alternative solutions as advocates for those affected by the cuts fight against the proposed cuts. “But these people are going to end up in the emergency rooms. They’re going to flood them.

“These people are already on the brink,” Reames continued. Though, at press time, no studies could be found linking a bad economy to an increase in substance abuse – Reames said that she and the counselors at Community Healing Center have seen the stress of financial hardship and job loss taking its toll.

“Absolutely,” she said. Looking at substance abuse as a “chronic progressive disease,” she said the circumstances for those suffering have been “compounded” by unemployment and homelessness and now face a lack of treatment available.

While programs would continue to exist, less people might be able to be taken care of through them, Proos did say. However, he added, lawmakers felt it important to focus on areas where the state is most vulnerable. In shaving off funding to the areas on the budget’s list, those dollars can be invested in areas such as agriculture and tourism and infrastructure in an effort to address the question on every public official’s desk at the moment, “how do we get Michigan residents back to work?”

“The tough choices need to be made and the debate about which choices we make has to be on the table,” he said.

It’s a debate those such as Reames are willing to have for the benefit of those in need of help in this particular area of community health. Those in need of help for substance abuse or mental health services, “are the least likely to speak up for themselves,” she said. “We have to become the advocates and encourage them to advocate for themselves. We were really stunned by the depth of that cut.”

Reames estimates that the Community Healing Center in Niles helps over 200 people each month through various services in mental health, substance abuse and support for veterans.

She hopes that legislators could find a way to streamline services, cut bureaucracy and seek out other solutions in order to save services like hers from facing a severe cut in funding.